Lived experiences of frontline workers and leaders during COVID-19 outbreaks in long-term care: A qualitative study.

BACKGROUND: Long-term care facilities across Canada have been disproportionately affected by the COVID-19 pandemic. This study aims to describe the experiences of frontline workers and leaders involved in COVID-19 outbreak management in these facilities, identify best practices, and provide recommendations for improvement. METHODS: This is a qualitative study using key informant, semi-structured interviews. Key informants were defined as individuals with direct experience managing COVID-19 outbreaks in long-term care. Thematic content analysis of interview transcripts identified key themes important for outbreak management. RESULTS: Twenty-three interviews were conducted with key informants from the following categories: public health, health authority leadership for long-term care, infection prevention and control, long-term care operators, and frontline staff. Eight themes were identified as critical factors for outbreak management on thematic analysis, which included: (1) early identification of cases, (2) the suite of public health interventions implemented, (3) external support and assistance, (4) staff training and education, (5) personal protective equipment use and supply, (6) workplace culture, organizational leadership and management, (7) coordination and communication, and (8) staffing. CONCLUSIONS: Best practices and areas for improvement in outbreak response identified in this study can help to inform policy and practice to reduce the impact of COVID-19 in these settings.

Evaluation of a multisectoral intervention to mitigate the risk of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission in long-term care facilities.

OBJECTIVE: A Canadian health authority implemented a multisectoral intervention designed to control severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission during long-term care facility (LTCF) outbreaks. The primary objective was to evaluate the effectiveness of the intervention 14 days after implementation. DESIGN: Quasi-experimental, segmented regression analysis. INTERVENTION: A series of outbreak measures classified into 4 categories: case and contact management, proactive case detection, rigorous infection control practices and resource prioritization and stewardship. METHODS: A mixed-effects segmented Poisson regression model was fitted to the incidence rate of coronavirus disease 2019 (COVID-19), calculated every 2 days, within each facility and case type (staff vs residents). For each facility, the outbreak time period was segmented into an early outbreak period (within 14 days of the intervention) and postintervention period (beyond 14 days following the intervention). Model outputs quantified COVID-19 incidence trend and rate changes between these 2 periods. A secondary model was constructed to identify effect modification by case type. RESULTS: The significant upward trend in COVID-19 incidence rate during the early outbreak period (rate ratio [RR], 1.07; 95% confidence interval [CI], 1.03-1.11; P < .001) reversed during the postintervention period (RR, 0.73; 95% CI, 0.67-0.80; P < .001). The average trend did not differ by case type during the early outbreak period (P > .05) or the postintervention period (P > .05). However, staff had a 70% larger decrease in the average rate of COVID-19 during the postintervention period than residents (RR, 0.30; 95% CI, 0.10-0.88; P < .05). CONCLUSIONS: Our study provides evidence for the effectiveness of this intervention to reduce the transmission of COVID-19 in LTCFs. This intervention can be adapted and utilized by other jurisdictions to protect the vulnerable individuals in LTCFs.